A4M COMPREHENSIVE ANSWERS AND QUESTIONS
SET A+
✔✔Immuno-modulatory antibody that controls B cell activation - ✔✔IgD
✔✔T or F: cell mediated immunity can be actively transferred from one person to
another - ✔✔F
✔✔Complexes that interact with immune cells and antigens to control Ag-Ab reactions
and determine self from non-self - ✔✔MHC (major histocompatability complex)
✔✔T or F: persistently low albumin is a sign of chronic inflammation - ✔✔T
✔✔Basic tests of immune function - ✔✔hs-CRP; IgA, IgG, IgM, neutrophil, monocyte
and lymphocyte counts; iron panel and serum albumin
✔✔T or F: deficiency of Vitamin A reduces the integrity of the mucosal barriers - ✔✔T
✔✔T or F: supplementation with Vit A produces a better and safer response to
vaccinations - ✔✔T
✔✔T or F: Vitamin C should be taken with meals - ✔✔False. vitamin C taken with
meals, especially those rich in iron, may worsen active infection, since bacteria utilize
iron for reproduction.
✔✔Mechanism of action of thiazolidenediones (pioglitazone) - ✔✔Insulin sensitizers; act
on PPAR pathways to modulate the transcription of genes involved in glucose
metabolism
✔✔Mechanism of action of sulfonylureas - ✔✔Stimulate insulin release by inhibiting the
ATP-dependent potassium channel on pancreatic beta cells
,✔✔Mechanism of action of alpha-glucosidase inhibitors (acarbose) - ✔✔Delay glucose
absorption from GI tract
✔✔Mechanism of action of GLP-1 analogues (Victoza) - ✔✔Stimulate glucose-
dependent insulin secretion; promotes satiety; increases glucose dependent insulin;
slows stomach emptying; beta cell preservation
✔✔DDP-4 inhibitors (sitagliptin phosphate) - ✔✔slow inactivation of incretin hormones
(eg GLP-1), which stimulate glucose-dependent insulin secretion
✔✔natural methods of boosting glutathione - ✔✔Riboflavin (B2); L-glutamine; L-glycine;
whey protein; yogurt with live active cultures; NAC or L-cysteine; aged garlic extract;
onions and leeks; melatonin; selenium; alpha lipoic acid; curcumin; milk thistle
✔✔T or F: Vitamin K2 does not affect coagulation and can be taken safely by patients
on Coumadin therapy - ✔✔T
✔✔Mechanism of action of chromium - ✔✔Allows glucose transport into cells
✔✔Vitamin D benefits to cardiovascular health - ✔✔50% decrease relative risk of MI;
reduced risk of HTN due to effects on renin; lowered inflammation and hence lower hs-
CRP; suppressed foam cell formation by reducing oxidized LDL uptake in macrophages
✔✔Ways insulin resistance contributes to hormone imbalance - ✔✔Insulin resistance
leads to increased insulin secretion which increases 17,20 lyase activity and increases
DHEA levels. DHEA can then convert to T, which may be aromatized to E. Increases
insulin also has effects on hepatocytes leading to decreased SHBG, hence increased
free hormone. Overall effect is to increase free estrogen levels in body.
✔✔Metabolic syndrome criteria for diagnosis - ✔✔3/5 of following: Increased waist
circumference (> 40 inches men and > 35 inches women); Low HDL (< 40 for males, <
50 for females); high triglycerides (> 150); high fasting gluose; HTN.
✔✔What is HOMA-IR? - ✔✔HOMA-IR is a homeostatic model for insulin resistance
based on plasma levels of fasting insulin and glucose that is used to assess insulin
sensitivity.
✔✔What is adiponectin? - ✔✔Adiponectin is an adipose derived protein (adipokine) that
is protective against atherosclerosis. It moderates fat tissue, promotes insulin sensitivity;
and decreases hepatic glucose and lipid production.
✔✔T or F: Stage 1 Insulin resistance is associated with declining adiponectin levels;
normal to slightly elevated HOMA-IR; normal glucose; normal A1c; normal insulin and
normal pro-insulin. - ✔✔T
, ✔✔Features of stage 2 IR (insulin resistance) - ✔✔Decreased adiponectin; increasing
insulin; normal pro-insulin; high normal HOMA-IR; elevated insulin; high post-prandial
glucose. Beta cell impairment may be present.
✔✔Features of stage 3 IR. - ✔✔Elevated pro-insulin; elevated HOMA-IR; elevated
adiponectin; elevated insulin; high A1c and high glucose.
✔✔At what age does sarcopenia begin - ✔✔Sarcopenia begins at age 50, and
progressively worsens, affecting 30% of people over 60 and 50% of those > 80
✔✔Supplements that may help combat sarcopenia - ✔✔Vitamin D; glucosamine;
creatine; colostrum; whey protein; amino acids; HMB; carnitine; omega 3 fatty acids;
HRT; trace elements; human growth hormone
✔✔Optimal level of homocysteine - ✔✔<10; also do not want it too low as this reflects
over-methylation
✔✔Changes observed in lung parenchyma with aging - ✔✔Reduced elastic recoil and
progressive reduction in compliance due to stiffening of chest wall lead to decreased
vital capacity and increased residual volume. Total lung capacity remains constant.
FEV1 decreases.
✔✔Supplements that lower homocysteine - ✔✔Vitamins B12, B6, folate, MTHF, TMG,
garlic, SAME, beets, broccoli
✔✔What is fibrinogen and how is it treated? - ✔✔Fibrinogen is a clot promoting
substance that contributes to risk of MI. It can be lowered by HRT; garlic; fish oil;
bromelain; Vitamin E; gingko and green tea
✔✔What is Lp(a)? - ✔✔Is a small cholesterol particle that
causes inflammation and can clog
blood vessels.
• Research has shown that people
with high lipoprotein (a) have a 70%
higher risk of developing heart
disease over 10 years.
✔✔T or F: statin drugs elevate Lp(a) - ✔✔T
✔✔Ways to lower Lp(a) - ✔✔Natural HRT; fish oil; Vitamin C; niacin; L-carnitine;
coenzyme Q10; L-lysine; L-proline; flax seed. If these methods fail, can use nattokinase
+ Vitamin C.
SET A+
✔✔Immuno-modulatory antibody that controls B cell activation - ✔✔IgD
✔✔T or F: cell mediated immunity can be actively transferred from one person to
another - ✔✔F
✔✔Complexes that interact with immune cells and antigens to control Ag-Ab reactions
and determine self from non-self - ✔✔MHC (major histocompatability complex)
✔✔T or F: persistently low albumin is a sign of chronic inflammation - ✔✔T
✔✔Basic tests of immune function - ✔✔hs-CRP; IgA, IgG, IgM, neutrophil, monocyte
and lymphocyte counts; iron panel and serum albumin
✔✔T or F: deficiency of Vitamin A reduces the integrity of the mucosal barriers - ✔✔T
✔✔T or F: supplementation with Vit A produces a better and safer response to
vaccinations - ✔✔T
✔✔T or F: Vitamin C should be taken with meals - ✔✔False. vitamin C taken with
meals, especially those rich in iron, may worsen active infection, since bacteria utilize
iron for reproduction.
✔✔Mechanism of action of thiazolidenediones (pioglitazone) - ✔✔Insulin sensitizers; act
on PPAR pathways to modulate the transcription of genes involved in glucose
metabolism
✔✔Mechanism of action of sulfonylureas - ✔✔Stimulate insulin release by inhibiting the
ATP-dependent potassium channel on pancreatic beta cells
,✔✔Mechanism of action of alpha-glucosidase inhibitors (acarbose) - ✔✔Delay glucose
absorption from GI tract
✔✔Mechanism of action of GLP-1 analogues (Victoza) - ✔✔Stimulate glucose-
dependent insulin secretion; promotes satiety; increases glucose dependent insulin;
slows stomach emptying; beta cell preservation
✔✔DDP-4 inhibitors (sitagliptin phosphate) - ✔✔slow inactivation of incretin hormones
(eg GLP-1), which stimulate glucose-dependent insulin secretion
✔✔natural methods of boosting glutathione - ✔✔Riboflavin (B2); L-glutamine; L-glycine;
whey protein; yogurt with live active cultures; NAC or L-cysteine; aged garlic extract;
onions and leeks; melatonin; selenium; alpha lipoic acid; curcumin; milk thistle
✔✔T or F: Vitamin K2 does not affect coagulation and can be taken safely by patients
on Coumadin therapy - ✔✔T
✔✔Mechanism of action of chromium - ✔✔Allows glucose transport into cells
✔✔Vitamin D benefits to cardiovascular health - ✔✔50% decrease relative risk of MI;
reduced risk of HTN due to effects on renin; lowered inflammation and hence lower hs-
CRP; suppressed foam cell formation by reducing oxidized LDL uptake in macrophages
✔✔Ways insulin resistance contributes to hormone imbalance - ✔✔Insulin resistance
leads to increased insulin secretion which increases 17,20 lyase activity and increases
DHEA levels. DHEA can then convert to T, which may be aromatized to E. Increases
insulin also has effects on hepatocytes leading to decreased SHBG, hence increased
free hormone. Overall effect is to increase free estrogen levels in body.
✔✔Metabolic syndrome criteria for diagnosis - ✔✔3/5 of following: Increased waist
circumference (> 40 inches men and > 35 inches women); Low HDL (< 40 for males, <
50 for females); high triglycerides (> 150); high fasting gluose; HTN.
✔✔What is HOMA-IR? - ✔✔HOMA-IR is a homeostatic model for insulin resistance
based on plasma levels of fasting insulin and glucose that is used to assess insulin
sensitivity.
✔✔What is adiponectin? - ✔✔Adiponectin is an adipose derived protein (adipokine) that
is protective against atherosclerosis. It moderates fat tissue, promotes insulin sensitivity;
and decreases hepatic glucose and lipid production.
✔✔T or F: Stage 1 Insulin resistance is associated with declining adiponectin levels;
normal to slightly elevated HOMA-IR; normal glucose; normal A1c; normal insulin and
normal pro-insulin. - ✔✔T
, ✔✔Features of stage 2 IR (insulin resistance) - ✔✔Decreased adiponectin; increasing
insulin; normal pro-insulin; high normal HOMA-IR; elevated insulin; high post-prandial
glucose. Beta cell impairment may be present.
✔✔Features of stage 3 IR. - ✔✔Elevated pro-insulin; elevated HOMA-IR; elevated
adiponectin; elevated insulin; high A1c and high glucose.
✔✔At what age does sarcopenia begin - ✔✔Sarcopenia begins at age 50, and
progressively worsens, affecting 30% of people over 60 and 50% of those > 80
✔✔Supplements that may help combat sarcopenia - ✔✔Vitamin D; glucosamine;
creatine; colostrum; whey protein; amino acids; HMB; carnitine; omega 3 fatty acids;
HRT; trace elements; human growth hormone
✔✔Optimal level of homocysteine - ✔✔<10; also do not want it too low as this reflects
over-methylation
✔✔Changes observed in lung parenchyma with aging - ✔✔Reduced elastic recoil and
progressive reduction in compliance due to stiffening of chest wall lead to decreased
vital capacity and increased residual volume. Total lung capacity remains constant.
FEV1 decreases.
✔✔Supplements that lower homocysteine - ✔✔Vitamins B12, B6, folate, MTHF, TMG,
garlic, SAME, beets, broccoli
✔✔What is fibrinogen and how is it treated? - ✔✔Fibrinogen is a clot promoting
substance that contributes to risk of MI. It can be lowered by HRT; garlic; fish oil;
bromelain; Vitamin E; gingko and green tea
✔✔What is Lp(a)? - ✔✔Is a small cholesterol particle that
causes inflammation and can clog
blood vessels.
• Research has shown that people
with high lipoprotein (a) have a 70%
higher risk of developing heart
disease over 10 years.
✔✔T or F: statin drugs elevate Lp(a) - ✔✔T
✔✔Ways to lower Lp(a) - ✔✔Natural HRT; fish oil; Vitamin C; niacin; L-carnitine;
coenzyme Q10; L-lysine; L-proline; flax seed. If these methods fail, can use nattokinase
+ Vitamin C.
